AChE inhibitors (OD)

Sxs: miosis, salivation, sweats, GI cramps, diarrhea, muscle twitches, seizures, coma, respiration failure

Intervention: atropine + pralidoxime, respiratory support 

Atropine & muscarine blockers (OD)

Sxs: inc. HR, BP, hyperthermia (hot,dry skin), delirium, hallucinations, mydriasis

Intervention: control CV sxs and hyperthermia + physostigmine

Carbon monoxide (OD)

Sxs: N/V, dyspnea w/ hyperventilation, mydriasis, vertigo, CV signs, dec. BP, syncope, inc. HR, arrhythmias

Intervention: Hyperbaric O2 and decontamination

CNS stimulants (OD)

Sxs: anxiety/agitation, hyperthermia (warm, sweaty skin), mydriasis, inc. HR, inc. BP, psychosis, seizures

Intervention: control CV symptoms, hyperthermia, and seizures (+/- BZs or antipsychotics)

Opioid analgesics (OD)

Sxs: lethargy, sedation, dec. HR/BP, hypoventilation, miosis, coma, respiratory failure

Intervetion: ventilatory support, naloxone at frequent intervals

Salicylates (ASA), (OD)

Sxs: confusion, lethargy, hyperventilation, hyperthermia, dehydration, hypokalemia, acidosis, seizures, coma

Intervention: correct acidosis and electrolytes, urinary alkalinization, possible hemodialysis

Sedative-hypnotics and ethanol (OD)

Sxs: disinhibtion, lethargy, ataxia, nystagmus, stupor, coma, hypothermia, respiratory failure

Intervention: ventilatory support, flumazenil if BZ's implicated

SSRI's (OD)

Sxs: agitation, confusion, hallucination, muscle rigidity, hyperthermia, inc. HR/BP, seizures

Intervention: control hyperthermia and seizures, possible use of cyproheptadine, antipsychotics and BZs

TCA's (OD)

Sxs: mydriasis, hyperthermia (hot,dry skin), 3 C's (convulsions, coma, cardiotoxicity) --> arrhythmias

Intervention: control seizures and hyperthermia, correct acidosis and possible antiarrhythmics

Arsenic (wood preservatives, pesticides, ant poisons)

Sxs:

Acute: gastroenteritis, hypotension, metabolic acidosis, garlic breath, "rice water" stools, torsades, seizures

Chronic: pallor, skin pigmentation (raindrop pattern), alopecia, stocking glove neuropathy, myelosuppression

Interventions: activated charcoal, dimercaprol, penicillamine

Iron (OD)

Acute: mainly kids, severe GI distress --> necrotizing gastroenteritis w/ hematemesis and bloody diarrhea, dyspnea, shock, coma

Intervention: gastric aspiration + carbonate lavage, deferoxamine IV

Lead (OD)

Acute: N/V, GI distress and pain, malaise, tremor, tinnitus, paresthesias, encephalopathy (red/black feces)

 Chronic: multisystem effects --> anemia (dec. heme synthesis), neuropathy (wrist drop), nephropathy (proteinuria), hepatitis, MR (from pica), dec. fertility and inc. still births

Intervention: gastric lavage + dimercaprol or EDTA or succimer in kids

Mercury (OD)

batteries, dyes, electroplating, fireworks, photography

acute: vapor inhalation (chest pain, dyspnea, pneumonitis)

inorganic salt ingestion (hemorrhagic gastroenteritis, acute tubular necrosis, shock

Chronic: CNS effects, ataxia, paresthesias, auditory and visual loss, loosening of teeth

Intervention: Succimer or dimercaprol

Acetylcysteine

Atropine + pralidoxime

Deferoxamine

Dimercaprol

Antidote for arsenic, gold, mercury, lead

Give oral succimer for milder lead and mercury toxicity

EDTA

Esmolol

Ethanol, fomepizole

Flumazenil

Naloxone

Oxygen

Penicillamine

Physostigmine

Protamine

vitamin K

Activated charcoal

Gingko

Uses: intermittent claudication

MOA?: antioxidant, free radical scavenger, increases NO

SE: anxiety, GI distress, insomnia, antiplatelet (use w/ caution when taking anticoagulant!!)

Saw palmetto

Uses: symptomatic BPH

MOA: 5 alpha reductase inhibitor and adrogen receptor atagonist

SE: GI pain, decreased libido, HA, HTN

St. John's wort

Uses: depressive disorder

MOA?: may enhance brain 5HT functions

SE: major drug interactions, serotonin syndrome w/ SSRI's, induces P450